Saturday, December 29, 2012

Why Do We Get Brain Freeze? Scientists Explain

Editor's Choice
Main Category: Headache / Migraine
Also Included In: Neurology / Neuroscience
Article Date: 23 Apr 2012 - 10:00 PDT Current ratings for:
Why Do We Get Brain Freeze? Scientists Explain
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Harvard Medical School scientists who say they have a better idea of what causes brain freeze, believe that their study could eventually pave the way to more effective treatments for various types of headaches, such as migraine-related ones, or pain caused by brain injuries.

Brain freeze, also known as an ice-cream headache, cold-stimulus headache, or sphenopalatine ganglioneuralgia, is a kind of short-term headache typically linked to the rapid consumption of ice-cream, ice pops, or very cold drinks.

Brain freeze occurs when something extremely cold touches the upper-palate (roof of the mouth). It normally happens when the weather is very hot, and the individual consumes something too fast.

Dr. Jorge Serrador, a cardiovascular electronics researcher, who presented the team's finding at the Experimental Biology 2012 meeting, San Diego, explained that until now, scientists have not been able to fully understand what causes brain freeze.

Dr. Serrador and team recruited 13 healthy adult volunteers. They were asked to sip ice-cold water through a straw, so that the liquid would hit their upper palate. Blood flow in their brain was monitored using a transcranial Doppler test.

They found that the sensation of brain freeze appears to be caused by a dramatic and sudden increase in blood flow through the brain's anterior cerebral artery. As soon as the artery constricted, the brain-freeze pain sensation wore off.

The scientists were able to trigger the artery's constriction by giving the volunteers warm water to drink.

Dr. Serrador explained that we already know that migraine sufferers are more likely to suffer brain freeze after drinking or eating very cold foods/drinks, compared to people who never have migraines. He suggests that some of what occurs during brain freeze may be similar to what causes migraines, and possibly other kinds of headaches, including those caused by traumatic brain injuries.

Serrador and team believe that local changes in brain blood flow may be causing other types of headaches. If this can be confirmed in further studies, new medications that prevent or reverse vasodilation (widening of the blood vessels) may help treat headaches.

Brain freeze-01A
Brain freeze can occur if you eat an ice cream too fast

Dr. Serrador said:
"The brain is one of the relatively important organs in the body, and it needs to be working all the time.

It's fairly sensitive to temperature, so vasodilation might be moving warm blood inside tissue to make sure the brain stays warm."

If dilated arteries cause a sudden rush of blood to the brain, which raises pressure and causes pain, a drug that constricts the blood vessel should reduce pressure and eliminate the pain. Also, constricting the blood vessels that supply the brain could help prevent pressure building up dangerously high.

Written by Joseph Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our headache / migraine section for the latest news on this subject. Experimental Biology 2012 meeting, San Diego, California. Please use one of the following formats to cite this article in your essay, paper or report:

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29 Dec. 2012. APA

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posted by kate on 24 Apr 2012 at 7:33 am

bill, i could agree w/ you more. since i started eliminating pretzels(malted barley) vanilla flavoring and spinach among other things (msg i always avoided) i am mostly headache free....almost unbelievable!! I also added butterbur to my diet and am 100% better by associating whatever food i ate the day before with the headache......i also recently mentioned food being the culprit to my neurologist. i've also learned that caffeine(which will restrict the blood vessels)works well to help ease headache.(caffeine pills can be purchased at walmart)my neurologist said that caffeine added to whatever headache meds you take can help them work better and faster.. caffeine is already in excedrin migraine medicine.

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posted by Maya on 24 Apr 2012 at 6:42 am

For decades I have also headaches from air-conditioners and cold winds (drafts included), but have physicians telling me that I cannot get migraine from cold. I guess this study is too narrow - they should have researched general effect cold has on our brains when we are exposed to cold: air-conditioners blowing VERY cold air right into our heads in public places are ideal for this kind of research.

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posted by George on 23 Apr 2012 at 11:14 pm

I feel like this study was made only so a few "scientists" could have some free ice cream to "study" with

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posted by CB on 23 Apr 2012 at 11:38 am

I have started to get these Brain freezes more and more when I drink frozen type drinks. I have always thought that this was due to the fact that the blood going to my brain is being cooled and that the cooler blood is what caused the headache. Also, if you consider the fact that our blood is always at around 99 degrees, so having it drop even a fraction could certainly have an effect. I try to have a glass of warm water on hand, which does instantly relieve the pain when this occurs.

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posted by Isaac on 23 Apr 2012 at 11:02 am

I've known about this for the past 6 years. This isn't a new discovery.

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posted by Bill on 23 Apr 2012 at 10:36 am

None of my migraines are caused by cold or freezing food. Most seem associated with food. My best guess, after a lifetime of migraines, is that migraines - with nausea - are a primitive protection from what the body perceives to be poison. Hence the vomiting to rid the body of the threat. The increased blood flow to the brain is the same system operating to flush the brain of perceived poison. I hope I live to see the answer through research.

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'Why Do We Get Brain Freeze? Scientists Explain'

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'Brain Freeze' Headaches May Be Caused By Changes In Brain's Blood Flow

Main Category: Headache / Migraine
Article Date: 24 Apr 2012 - 1:00 PDT Current ratings for:
'Brain Freeze' Headaches May Be Caused By Changes In Brain's Blood Flow
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'Brain freeze' is a nearly universal experience - almost everyone has felt the near-instantaneous headache brought on by a bite of ice cream or slurp of ice-cold soda on the upper palate. However, scientists are still at a loss to explain this phenomenon. Since migraine sufferers are more likely to experience brain freeze than people who don't have this often-debilitating condition, brain freeze may share a common mechanism with other types of headaches, including those brought on by the trauma of blast-related combat injuries in soldiers. One possible link between brain freeze and other headache types is local changes in brain blood flow.

In a new study, Melissa Mary Blatt, Michael Falvo, and Jessica Jasien of the Department of Veterans Affairs New Jersey Health Care System, Brian Deegan and Gearold O Laighin of the National University of Ireland Galway, and Jorge Serrador of Harvard Medical School and the War Related Illness and Injury Study Center of the Veterans Affairs New Jersey Health Care System use brain freeze as a proxy for other types of headaches. By bringing on brain freeze in the lab in volunteers and studying blood flow in their brains, the researchers show that the sudden headache seems to be triggered by an abrupt increase in blood flow in the anterior cerebral artery and disappears when this artery constricts. The findings could eventually lead to new treatments for a variety of different headache types.

An abstract of their study entitled, "Cerebral Vascular Blood Flow Changes During 'Brain Freeze,'" was discussed at the meeting Experimental Biology 2012 being held April 21-25 at the San Diego Convention Center. The abstract is sponsored by the American Physiological Society (APS), one of six scientific societies sponsoring the conference, which last year attracted some 14,000 attendees.

Bringing on Brain Freeze

According to study leader Serrador, previous studies meant to assess what physiological changes might prompt headaches have mainly relied on various drugs, or brought in patients already in the throes of a migraine to the lab. However, both methods have their limitations. Pharmacological agents can induce other effects that can make research results misleading, he says, and since researchers can't wait for migraine sufferers to experience a migraine in the lab, those studies miss the crucial period of headache formation that occurs sometimes hours before scientists were able to study these patients.

To induce headache inside the lab and study it from start to finish, Serrador explains, brain freeze is a perfect fit. It's easy to bring on and resolves quickly without expensive or complicated equipment or drugs.

In this study, Serrador and his colleague recruited 13 healthy adults. The researchers monitored the volunteers' blood flow in several brain arteries using transcranial Doppler while they first sipped ice water with the straw pressed against their upper palate - ideal conditions for bringing on brain freeze - and then while sipping the same amount of water at room temperature. The volunteers raised their hand once they felt the pain of a brain freeze, then raised it again once the pain dissipated. Findings showed that one particular artery, called the anterior cerebral artery, dilated rapidly and flooded the brain with blood in conjunction to when the volunteers felt pain. Soon after this dilation occurred, the same vessel constricted as the volunteers' pain receded.

Changing the Course of Headaches

Serrador and his colleagues speculate that the dilation, then quick constriction, may be a type of self-defense for the brain. "The brain is one of the relatively important organs in the body, and it needs to be working all the time," he explains. "It's fairly sensitive to temperature, so vasodilation might be moving warm blood inside tissue to make sure the brain stays warm." But because the skull is a closed structure, Serrador adds, the sudden influx of blood could raise pressure and induce pain. The following vasoconstriction may be a way to bring pressure down in the brain before it reaches dangerous levels.

He notes that similar alterations in blood flow could be at work in migraines, posttraumatic headaches, and other headache types. If further research confirms these suspicions, then finding ways to control blood flow could offer new treatments for these conditions. Drugs that block sudden vasodilation or target channels involved specifically in the vasodilation of headaches could be one way of changing headaches' course.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our headache / migraine section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:

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''Brain Freeze' Headaches May Be Caused By Changes In Brain's Blood Flow'

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Childhood Headaches Activated By Stress - ENS 2012

Main Category: Pediatrics / Children's Health
Also Included In: Neurology / Neuroscience;  Anxiety / Stress;  Headache / Migraine
Article Date: 13 Jun 2012 - 0:00 PDT Current ratings for:
Childhood Headaches Activated By Stress - ENS 2012
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School and computer stress trigger childhood headaches

Stress factors are among the most important triggers of headaches and migraines in children, Italian researchers reported at the Meeting of the European Neurological Society in Prague. School stress and nightly computer sessions ranked highest among the causes of such pain.

Stress factors were the trigger for headaches or migraine attacks in two-thirds of the children examined at an outpatient clinic, Italian researchers reported at the 22nd Meeting of the European Neurological Society (ENS) in Prague. "In 72% of the cases we studied, stress could be identified as a major factor behind their headaches," said Dr Dacia Dalla Libera (San Raffaele Institute, Milan). "School stress and a burdensome lack of sleep due to night time computer or television activities head the list of frequent stress factors. In the future, we will need to incorporate these insights much more into the individual counselling and therapy of childhood headache patients."

More and more children and adolescents suffer from headaches. In studies during the mid 1970s, only 14% of children and young people admitted to having suffered from a headache in the previous six months. Now, every other child is familiar with the painful condition. In adolescents between eleven and 18 years of age, migraine affects 7% of boys and 12% of girls. There are no guaranteed hypotheses as to why headaches occur more and more among young patients. It is assumed, however, that an unfavourable lifestyle is partially responsible.

School and IT stress: most important trigger factors

At the Headache Center of the San Raffaele Institute in Milan, the research group assessed the headaches and migraine history of 125 children and adolescents. Standardised interviews with parents were conducted in order to determine the cause of the children's painful attacks in detail. Among those children for whom stress played a role as trigger factor, 78% - the highest ranking - was attributed to school related stress: among the essential elements, that included academic stress, exhaustive reading assignments and homework, exams, fear of failure but also bullying in the classroom.

In second place, involving 68% of the cases, sleep deprivation was identified as a trigger factor - caused by nightly television, computer games or use of social networking. Other stress factors triggering pain were family stress (25%), travelling (20%), extracurricular activities such as sport (20%), environmental factors such as weather changes or noise (10%), or stressful life events such as the illness or death of someone close (10%). For many of the children studied, the researchers also found other symptoms in addition to headaches that were caused by stress, such as stomach aches, nightmares or trouble concentrating.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pediatrics / children's health section for the latest news on this subject. ENS Abstract P 485: The importance of stress as trigger factor in childhood migraine: a retrospective study. Please use one of the following formats to cite this article in your essay, paper or report:

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PastaQueen runs to benefit from the National Headache Foundation

Although Author Jennette Fulda had the willpower to half her body weight to lose, they do not have the magical power to get rid of the headaches that she has had for more than a year and a half.

Tired of the pain and countless treatments, Fulda, whose online alias is "PastaQueen" and decided that they needed to take action. On 15 August, the PastaQueen on her running shoes and ready A Midsummer night's Run, a 5 K race in Lexington, KY with a time of 7 seconds.

"There were not many water stations, so my time ago, but I was glad to finish the race," Fulda said, "I hope to improve on my next 5 K next month on [my time]."

Fulda ran not only because her doctors told her that regular exercise can improve headaches, but because she wanted to raise awareness about headaches to help other patients. With her ultimate fundraising goal of $ 3,000, Fulda encouraged her friends and fans to sponsor her in the race by donating to the National Foundation for headaches Migraine million campaign. The Migraine million campaign goal is to increase from 1 million dollars for Headache Education and research. The National Headache Foundation hopes one million of the nearly 30 million migraine sufferers in America to donate $ 1 or more to this rally initiative.

"I wanted to keep the race finish myself responsible so I would and I knew that if I would have me money people to complete. I wanted to raise money for the cause for people like me who are suffering with headaches, and I thought the National Headache Foundation is a great place to donate, "Fulda said.

Fulda gained national media recognition with her 2008 book half-assed: a weight loss memoir, which was inspired by her online blog that chronicled her weight-loss of 372 to 180 pounds. In November of 2004 Fulda, then 24, began to keep track of her weight loss. In February 2008, but she had lost more than half her body weight, Fulda developed a debilitating headache that has yet to disappear.

"It was kind of ironic. I was in the best shape of my life and I got this tension-type headache that just wouldn't go away, "said Fulda.

Because of the pain from the constant headache Fulda gained back 30 pounds in the fall of 2008. Although they started to exercise again in attempt to relieve pain and her head back in tip-top shape, Fulda has decided to her experiences with the world for a second time. The Indiana-based author is currently working on her next book, tentatively titled chocolate and Vicodin: and other failed Cures for the headache that wouldn't go away.

Although the race is over, Fulda hopes to continue to raise awareness about headaches. Donations can still be made to the National Headache Foundation on the author fundraising site (http://firstgiving.com/pastaqueen) or on the National Headache Foundation's Web site (http://www.headaches.org/store/donations.html?cat=253) of Fulda blog can be seen on http://www.pastaqueen.com.


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Migraines - Many Treatments Work, But Few Use Them

Editor's Choice
Academic Journal
Main Category: Headache / Migraine
Article Date: 23 Apr 2012 - 21:00 PDT Current ratings for:
Migraines - Many Treatments Work, But Few Use Them
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Although several preventive migraine treatments are very effective for many patients, few sufferers use them, according to new American Academy of Neurology guidelines. The guidelines have been published in the journal Neurology and will be presented tomorrow at the American Academy of Neurology's 64th Annual meeting in New Orleans.

Author Stephen D. Silberstein, MD, FACP, FAHS, of Jefferson Headache Center at Thomas Jefferson University in Philadelphia and a Fellow of the American Academy of Neurology, said:

"Studies show that migraine is underrecognized and undertreated. About 38 percent of people who suffer from migraine could benefit from preventive treatments, but only less than a third of these people currently use them."

Preventive treatments are generally administered daily to prevent migraine attacks from ever occurring, or to lessen their severity and length of duration if they do.

Silberstein said:

"Some studies show that migraine attacks can be reduced by more than half with preventive treatments."

All evidence related to migraine prevention was reviewed before the guidelines were made.

The following prescription medications were found to be effective in preventing migraine attacks, or at least reducing their severity and/or duration: divalproex sodium (a seizure medication)sodium valproate (a seizure medication) topiramate (a seizure medication)metoprolol (beta blocker)propranolol (beta blocker)timolol (beta blocker)The guidelines say that doctors should offer these medications for the prevention or reduction in frequency or severity of migraine attacks.

The guidelines say that Lamotrigine, a seizure medication, does not prevent migraine.

According to the guideline, herbal preparation Petasites (butterbur) can effectively prevent migraine attacks.

The following were also found to be effective: NSAIDs (nonsteroidal anti-inflammatory drugs)
FenoprofenIbuprofenKetoprofenNaproxen and naproxen sodiumSubcutaneous histamine
Complementary treatments
MagnesiumMIG-99 (feverfew) RiboflavinEven though patients do not require a prescription for these OTC medications and complementary therapies, Dr. Silberstein said that patients should still visit their doctor for their scheduled follow-up appointments.

Silberstein said:

"Migraines can get better or worse over time, and people should discuss these changes in the pattern of attacks with their doctors and see whether they need to adjust their dose or even stop their medication or switch to a different medication. In addition, people need to keep in mind that all drugs, including over-the-counter drugs and complementary treatments, can have side effects or interact with other medications, which should be monitored."

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our headache / migraine section for the latest news on this subject. "Update: Pharmacologic Treatment for Episodic Migraine Prevention in Adults"
S.D. Silberstein, S. Holland, F. Freitag, et al.
Neurology 2012;78;1337. DOI 10.1212/WNL.0b013e3182535d20

"Update: NSAIDs and Other Complementary Treatments for Episodic Migraine Prevention in Adults"
S.D. Silberstein, S. Holland, F. Freitag, et al.
Neurology 2012;78;1346. DOI 10.1212/WNL.0b013e3182535d0c

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posted by Helen S on 12 May 2012 at 4:04 am

My son developed a migraine in March last year and it has never gone away, from the minute he wakes up till he finally falls asleep that pain is with him always. it is continuous. They also had a possibly incidental finding of a huge arachnoid cyst on his brain He has been hospitalised twice and he only turned 16 this christmas. He tried topirimate for 6 months last year which did no good, he is about to complete 6 months of the highest dosage he can take of propranalol which has also made no difference, he also had no side effects we could detect, he is also supposed to take ibuprofen and zomig twice a week, but as this also had no effect he has stopped. He has also tried acupuncture and reflexology which have also not helped. I understand the health professionals have got to try b/c for some people it will work and it must be worth it to help that one. what i have found interesting is all the alternatives you have found to help some of you, magnesium, feverfew etc. This has given me some avenues to pursue, thanx.

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posted by Kelly on 3 May 2012 at 9:11 pm

I must agree with "stupidmax". Haven't heard that analogy, but can relate. I tried topamax and stopped taking the drug b/c I immediately became extremely tired and the drug put me in this thick fog. There is no way any type of life functioning was going to take place on that drug. And taking it for the recommended 2 weeks for full effect was out of the question. Magnesium supplements seem to be effective for some sufferers-I think I will try this.

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posted by Laura Larrett on 25 Apr 2012 at 6:06 pm

I am 62 and 12 years ago, I started tp get daily migeraines and even imitrex did not work. A neurostimulator was put in and it worked well for 3 months then the leads fell off the nerve. They unhooked the wires but left the wires in and they poked thru my skin and I got a psuedomonas infection. We waited another year and they put another Medronic device but it never worked. I lost my insurance and am afraid of getting it out. This was 5 years ago. The only thing that worked at all was Feverfew 180 mg, B2 (4oo mg, magnesium 400 mg. Co Q 10 200 mg, and Butterburr,150 mg. I was always told they would go away at menopause but instead some women get more.

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posted by cathy morgan on 24 Apr 2012 at 7:56 am

most of the drugs listed i tried due to severe migraine starting in my teens...propranolol (beta blocker) and topamax cause weight gain of up to 30 lbs !!! and do not work !!!!!!also i developed colitis and the colonoscopy doctor told me ibuprofen is known to cause colitis!!!!i did not know that! PEOPLE DO NOT KEEP TAKING THEM B/C THEY DO NOT WORK...where did this doctor get his info?? and does he "lecture" for a pharmacutical company??

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posted by TrannyGirl on 24 Apr 2012 at 12:30 am

I've watched my room mate suffer with intense migraines for the last 3 years, on an almost daily basis. I've taken him to the doctor numerous times to be treated for pain so overwhelming that he was puking. I've taken him to the emergency room from the terrible reactions to almost every one of the medications on the list in this article.

He was NOT able to continue to use any of the prescription drugs due to life threatening reactions, hallucinations, nightmares or the complete failure of the drug to have any effect at all. The only legal item on the list that actually worked was Feverfew.

Today, he started on a regimen of enzymes and Feverfew that seems to be working the best of anything he's tried in 3 years.

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posted by H Nasr on 23 Apr 2012 at 11:32 pm

Great article! Knowing which prophylactic medication to use is usually a trial and error process. They certainly can take a few weeks to work, so it is important to try a particular medication for several weeks before giving up.

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posted by Chuck on 23 Apr 2012 at 11:24 pm

No wonder they no being used. Take "topiramate" - more people know it by it's brand name: Topamax. There's a good reason that most people who have tried it know it by its nickname: Stupidmax. How many of the other work by putting people so out of it that they can barely function? Come on people, the WHOLE story.

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posted by Sam on 23 Apr 2012 at 10:22 pm

I've had migraines my entire life. The single most helpful thing that I ever did, was to ask a good Chiropractor about helping me with them. With his guidance and the exercises he taught, I feel like I can conquer migraines. The severity and frequency of my migraines have significantly decreased. I only resort to Imitrex when I must.
I have tried topiramate. I felt that I would rather endure the worst migraines, than suffer the side effects from that drug!

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posted by john on 23 Apr 2012 at 10:05 pm

I have migrains once to twice per month. The kind where you shut down turn off the lights and try to be still. I take 2-3 advil and hope for the best. I have noticed that my migrains coorelate with high bp reading. I have home monitor and check when I have them vs. not. In all cases I have elevated bp. 130/95 plus.

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posted by md on 23 Apr 2012 at 9:49 pm

I an not one of those pp. U can call a health nut...yet, when my daughter was diagnosed with migraine headaches & the Dr.s were willing to have her medicated for life I tried a healthy approach which was suggested to me. My daughter has not eaten anything with wheat or sugar in it & let me tell u I learnt a whole new cooking & baking regime...everything is possible & we have access to so many sub products... (spelt flour, exilotol...) My child is a healed person... It's been two years now and I strongly encourage this approach!

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posted by Paul Dolph on 23 Apr 2012 at 9:46 pm

I was taking zomig two or three at a time to stop my daily migarines. About ten years ago I started taking 400mg of magnesium a day and I have not had a headache since.

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'Migraines - Many Treatments Work, But Few Use Them'

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Chronic Migraine Headache Sufferers Benefit Only Modestly From Botox Injections

Editor's Choice
Main Category: Headache / Migraine
Article Date: 24 Apr 2012 - 13:00 PDT Current ratings for:
Chronic Migraine Headache Sufferers Benefit Only Modestly From Botox Injections
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A study published in the April 25 issue of JAMA reveals that individuals suffering from chronic migraine headaches and chronic daily headaches may receive a small to modest benefit using botulinum toxin A ("Botox") injections. However, the researchers found botox did not provide greater benefit than placebo for preventing episodic migraine or chronic tension-type headaches.

The U.S. Food and Drug Administration approved botox for preventive treatment for chronic migraines.

The researchers explained:

"Migraine and tension-type headaches are common. Although up to 42 percent of adults experience tension-type headaches sometime in their life, most do not seek medical advice.

Migraines are less common, with a worldwide prevalence between 8 to 19%, but as associated with greater disability. Migraine headaches are responsible for $1 billion in medical costs and $16 billion in lost productivity per year in the United States alone."

Clinicians first observed that patients with chronic headaches experienced an improvement after receiving cosmetic botulinum toxin A injections. This resulted in various studies suggesting that botox injections were beneficial for patients with headaches. However, medical literature on botulinum efficacy for headaches has been mixed.

In order to determine whether botox is effective as preventative treatment of migraine, tension, or chronic daily headaches in adults, Jeffrey L. Jackson, M.D., M.P.H., of the Medical College of Wisconsin, Milwaukee, and his team examined 27 randomized placebo-controlled trials that included 5,313 individuals, as well as 4 randomized comparisons with other medications.

The researchers categorized headaches as: Episodic - less than 15 headaches per month
Chronic- (15+ headaches per month) migraine and episodic or chronic daily or tension headachesThe researchers found that individuals with chronic daily headaches who received botox had less headaches per month (1,115 patients, -2.06 headaches per month), as did those with chronic migraine headaches (1,508 patients, -2.30 headaches per month).

However, they found no considerable association between the use of botox and reduction in the number of chronic tension-type headaches (675, -1.43 headaches per month) or episodic migraine (1,838 patients, 0.05 headaches per month).

Compared with placebo, the researchers found that botox was linked to: Skin tightnessNeck stiffnessNeck painMuscle weaknessParesthesias (a prickly, tingling sensation)Greater frequency of blepharoptosis (drooping of the upper eyelid)In addition, the team discovered that botox did not lower the frequency of headache compared with topiramate (1.4 headaches per mont) or amitriptyline (2.1 headaches per month) for prophylaxis against chronic migraine headaches.

The researchers explained:

"Botulinum toxin A was not associated with a reduction in headache frequency vs. valproate in a study of patients with chronic and episodic migraines (0.84 headaches per month) or in a study of patients with episodic migraines (0.3 headaches per month).

Botulinum toxin A was associated with a greater reduction in average headache severity than methylprednisolone in a single trial among patients experiencing chronic tension-type headaches (-2.5 headaches per month)."

They conclude:

"Our analyses suggest that botulinum toxin A may be associated with improvement in the frequency of chronic migraine and chronic daily headaches, but not with improvement in the frequency of episodic migraine, chronic tension-type headaches, or episodic tension-type headaches.

However, the association of botulinum toxin A with clinical benefit was small. Botulinum toxin A was associated with a reduction in the number of headaches per month from 19.5 to 17.2 for chronic migraine and from 17.5 to 15.4 for chronic daily headaches."

Written By Grace Rattue

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New National Guidelines For Treatment Of Subarachnoid Hemorrhage

Main Category: Stroke
Also Included In: Blood / Hematology;  Headache / Migraine
Article Date: 19 May 2012 - 0:00 PDT Current ratings for:
New National Guidelines For Treatment Of Subarachnoid Hemorrhage
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People with bleeding brain aneurysms have the best chance of survival and full recovery if they receive aggressive emergency treatment from a specialized team at a hospital that treats a large number of patients like them every year, according to new guidelines just published by the American Stroke Association.

Diagnosing and immediately treating this kind of "bleeding stroke", and using advanced techniques to prevent re-bleeding and aneurysm recurrence, reduces the chance of immediate death and disability by 30 percent for patients with aneurysm-related subarachnoid hemorrhages (aSAH), according to the newly published guidelines.

What's more, this kind of evidence-based treatment means better long-term survival and quality of life for survivors, say the guideline's authors, who include University of Michigan neurosurgeon B. Gregory Thompson, M.D. The guideline is published online in the journal Stroke.

In a subarachnoid hemorrhage, blood collects on the surface of the brain after leaking from an aneurysm, or a weak spot in a brain blood vessel. About 5 percent of all strokes are caused by aSAH, which can occur at any time in any of the millions of Americans who have brain aneurysms.

Many people who suffer an aSAH have no idea they have an aneurysm. Their first sign is a severe headache - "the worst headache of their life" as many describe it - that comes on suddenly and doesn't fade away for hours if at all. The condition is often misdiagnosed.

The guidelines emphasize the importance of getting such patients diagnosed quickly - and transporting them immediately to a hospital that treats more than 35 aSAH patients in a year, which typically have a multi-specialty team available to quickly assess and treat each patient.

"The take-home message for physicians and patients is that admission to specialized high volume centers is associated with lower rates of death and disability," says Thompson, who heads U-M's cerebrovascular team and is the John E. McGillicuddy Collegiate Professor of Neurosurgery at the U-M Medical School.

Last year, more than 100 subarachnoid hemorrhage patients were treated by U-M's team, as well as more than 200 brain aneurysm patients who had their condition treated before a hemorrhage could occur.

Because each aneurysm is different, the team of physicians must decide quickly what technique they will use to prevent aneurysm re-bleeding. For some patients, the aneurysms are treated by microsurgery to "clip" the aneurysm - and for others, the treatment choice is use of minimally invasive endovascular (through the blood vessel) techniques, which employ coils, stents and other implants inserted through a catheter and threaded into the brain through blood vessels in the neck.

At a few highly specialized centers, such as U-M, a "brain bypass" operation that transplants a section of blood vessel from the arm or leg into the brain can be done for patients with "unclippable" or ruptured fusiform aneurysms, an especially complex type to repair.

Patients with an aSAH need to be treated within hours of the start of their hemorrhage, though the urgency is not quite as time sensitive as the more common type of stroke caused by a clot that blocks blood flow into the brain. In about 50 percent of patients with subarachnoid hemorrhage the blood clot at the site of the arterial weakening between the brain and skull stops the arterial leak long enough for the patients to survive and be treated successfully. But if the bleeding begins again before the aneurysm can be secured, the risk of death is even higher, says Thompson.

"We want to treat these patients within the first 24 hours after their hemorrhage, to prevent re-bleeding and to give them the best chance for full recovery," he says. "Mortality increases to 80 percent after a second hemorrhage."

That's why it's important for patients to seek emergency care for their initial symptoms, whether by calling 911 or going to a local hospital. And, the guidelines note, initial diagnostic imaging with CT, CT angiography or MRI, or cerebrospinal fluid analysis, is needed to pinpoint the cause of symptoms. The guideline also calls for the immediate use of drugs to bring down blood pressure.

Thompson notes that the availability of medical helicopters staffed by trained teams, such as U-M's Survival Flight, helps speed patients to a highly experienced hospital.

Even after the initial operation, careful management of aSAH patients in Intensive Care Units and after discharge from the hospital is also crucial, say the guideline authors. U-M's Neurointensive Care Unit is an example of the kind of specialized inpatient care that can increase the odds of healthy survival, says Thompson. After the hospital stay is over, patients can benefit from the kind of testing and treatment offered through programs such as U-M's Stroke Rehabilitation Program.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our stroke section for the latest news on this subject. The new guidelines were written by a team of clinicians with no major ties to industry, which helps ensure the independence of their recommendations. The full guideline is available for free at http://stroke.ahajournals.org/content/early/2012/05/03/STR.0b013e3182587839. DOI: 10.1161/STR.0b013e3182587839
In addition to Thompson, the guideline authors are Sander Connolly, Jr, Alejandro A. Rabinstein, J. Ricardo Carhuapoma, Colin P. Derdeyn, Jacques Dion, Randall T. Higashida, Brian L. Hoh, Catherine J. Kirkness, Andrew M. Naidech, Christopher S. Ogilvy, Aman B. Patel and Paul Vespa.
University of Michigan Health System Please use one of the following formats to cite this article in your essay, paper or report:

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'New National Guidelines For Treatment Of Subarachnoid Hemorrhage'

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